Susie Orbach. Studies in Gender and Sexuality. Volume 7, Issue 1. Winter 2006.

Drawing on the counter-transferential bodily experience of the analyst during specific therapies enables a fuller understanding of a person’s bodily development. The author further proposes that the body is an outcome of relational dynamics that bequeath specific cultural and familial understandings to the contemporary body. She suggests ways in which physical symptoms can be understood as a search on the part of the patient to create a body that is alive for her or him when there is an absence of a sense of body surety.

This would have been fine if I had got on all right with my body, but it and myself formed an odd couple. I fulfilled my alimentary duties and God sometimes, rarely, sent me that grace which permits you to eat without disgust (p. 56) … The mirror was a great help to me: I gave it the job of teaching me I was a monster (p. 69).

~ Jean Paul Sartre, Words

Sartre’s passing and yet poignant description of his difficulties with corporeality lead him to describe his body as an ugly thing apart from himself. His disenfranchisement from it was the means by which he attempted to set corporeality aside and use words, and only words, as a form of self-creation, the route to identity and his passage in the world.

In the interwar period, the officer class in Germany underwent a training that first deconstructed and then reconstructed their bodies in such a way that they developed, through repetitive brutal physical and mental pedagogy, a body armature that enabled them to feel that their bodies were impervious fighting machines: solid, impenetrable, steely structures fit to kill. The training took everything that had once been in any way vulnerable, soft, wild, or unpredictable and cast it off onto other bodies: the bodies of those the men would be encouraged to despise-the bodies of the weak, of the poor, of the undisciplined, of the unemployed, of the potentially frightening masses. Before the words projective identification were in general currency, the mechanisms of dissociation, projection, disavowal, and separation were at work in the training of the officer corps. Aspects of the body-a body that feels, a body that is pained, a body that has needs-became disdained and represented as a body that is feeble (Theweleit, 1989).

Today’s modern anorectic is not so different from the officer corps. A body of extreme vulnerability, a body that has needs, a body that has feelings, a body that registers hurt, a body that knows desire, a body that hungers is militarized by the person and transformed into a body that is apparently free of the needs that visit other bodies. The anorectic body requires little nourishment for sustenance. It can be subjected to extremes of deprivation that cause a certain discomfort. At the same time, overcoming those needs becomes a source of reassurance to the person as the capacity to resist works to bind up what are felt to be disruptive needs. Anorexia-not responding to hungeris a solution, not a problem; starvation is an answer, albeit an unstable and ever-demanding adaptation to the problematic of having a body (Orbach, 1986).

When we come to cyberspace, the categories age, gender, biological sex, pigmentation, sexual orientation, height, weight, nationality, and cultural background become imaginative fictions. Fictional bodies in which middle-aged men become girls, poor people present themselves as wealthy, straights as queer, and so on are deployed by those seeking contact and alternative self-definitions through the appropriation of other fixed categories. Paradoxically, precisely because of what such fixed markers indicate and encapsulate about the almost (bear in mind modern surgical interventions) immutable categories of age, sexuality, and race, for example, they become the tributaries for play in which individuality and selfhood can find some broader expression than that offered by the actual material and cultural circumstances the person has been brought up in. Identified by our various tribal affiliations, we strive to create something unique, distinctive, and fluid out of those very categories. We do not escape these categories even when we play with them. They mark our imaginative worlds, and an appropriated alternative embodiment is both the source and the means of the fantasy.

Victor, the feral child of Aveyron, discovered at age 11 in 1799, had been raised alongside the wolves and animals of the forest and was devoid of human relationship. He had failed to develop any of the markers of language, sexuality, or an upright gait that we associate with human corporeality. His apocryphal story, which predates the modern wild child Genie, demonstrates how profoundly early development incarcerates, in ways that defy and challenge the postmodern celebration of multiplicity, the particular materiality(ies) of the bodies we are first given. Wild children show us that there is no simple biological body, let alone an abundantly choice-filled body or a triumphant body. The body is more fixed by early experience than we may recognize. This fixity is not about gait and stance, as in Victor’s case. Rather, it is about the relation to the body. Where the body has been welcomed, treated in a consistent manner, its gestures mirrored, and so on, the sense that the body is stable and sure will prevail. Where the relation to the body has been unstable and inconsistent, or when the body’s gesture has gone unrecognized, then this instability will operate like a fixed structure.

Troubled Bodies

We are accustomed to the idea that troubled psyches reproduce troubled psyches and that the defense structures within the troubled psyche can be flexible enough to meet (and repel) almost any challenge.

So too with the body. Troubled bodies, out of a sense of insecurity, searching, and an attempt to become, may appear malleable, but, in fact, that apparent flexibility expresses precariousness not fluidity. Notice that the conventional postmodern binary between fixed and fluid now has to allow a third position. It is not sufficient to locate troubled bodies along a continuum between the poles of fixed and fluid but, rather, as invested with an entirely new affective dimension, a third pole of precariousness. This affective dimension of the apparently fluid body is what allows us insight into the pain of body insecurity. Thus, the many adaptations we observe-from puncturing, cutting, changing size, emphasizing a body part such as breasts or penis, those magnificent jeweled or leather accessories that decorate our feet, noses, hair, and wrists, and the donning of multiple body states-are not necessarily expressions of robust corporeality or potentialities that give reign to fluidity. Of course, they may well be. But they can also be understood as the creative responses to damage, paucity, and a sense of bodylessness and precariousness.

Like the “lostness” of a person who has an insecure or unstable sense of self and the diverse modes by which that core instability becomes expressed as the person endeavors to find a base and a sense of security, the person with, or residing in, or attempting to live in a troubled body makes many attempts to engage his or her physical sense. Like the psyches we are bequeathed and create, and with which we then live and that have everything to do with the cultural and psychological disposition of the psyches of those who raised us, so the bodies we are bequeathed and create, and with which we then live, have everything to do with the cultural and the psychological disposition of the bodies of those who first gave us our bodies as well as, of course, our internalization of their experience of their bodies.

Sam is biologically 13 years old, but his physical presence resembles that of a child entering first grade. He is slight and has just started to grow again after an eight-year shut-down-for which no medical reason could be given (Orbach and Granville, 2003). He was cared for during those same years by an experienced foster mother, Anne, who took him to numerous specialists but to little avail. Anne concluded that Sam’s stalled growth was the result of severe physical and emotional mistreatment by his family of origin, and she set herself the task of holding him and stroking him as though he were a little boy; and she tried to engender in him a sense that his body could grow. To Anne, Sam seemed cocooned, although perhaps that is too benign a word for her experience of his frozen corporeality, a child trepidatious, fearful of entering into her family or even into his own body.

The idea of a natural body, then, is nonsense and nonsensical. Despite the claims of the fundamentalist geneticists whose perverse play on the notion and desire for individuality allows them to proclaim, falsely, that true uniqueness lies in our personal ribbons of deoxyribonucleic acid, DNA, almost every aspect of our physicality, from the way we move our lips, tongue, eyes, and hands as we talk, to the way we walk, the way we sit or squat, the implements we select for eating, the way we do our toilette, the uniform we don in the morning, be it hijab or business suit, is created within a cultural, interpersonal matrix that encodes the ways in which our corporeality, our physicality, occurs.

Bodies Are Made

All our known ways of being create physical and neural pathways that become constitutive of self, not just on a psychological level but on a physical, material level. For example, the language we speak creates specific physical structures in our maxillary-facial muscles that become fixed. If we are not exposed to Chinese at a very early age, we lose the critical time periods when we could form characteristic Chinese sounds. The Xhosa click is almost impossible if not heard and practiced from a young age. Closer to home, Henry Higgins could spot London accents by the neighborhood and demonstrated that turning Eliza Doolittle into a “Lady” required full-time reeducation.

Sexuality, as is well known, also has many different cultural forms.1 Who would have thought that there are peoples-the nomadic Siriono of Eastern Bolivia-who do not know about kissing? Or peoples like the Miao, who forbid it? For these mountain people of Southwest China, or the Kyopoe Amazonian people, for whom biting, not the fleshy embrace and search of lips on lips and lips on that great organ, skin, is the way to show affection and lust (personal communication, T. Eve, 2004), kissing is missing from their sexual practices.

Even gestation is culturally inflected. Prenatal life in the maternal womb is shaped by a mother’s mental state (Glover, Giatu, and Fisk, 2001). Generally, the fetus’ neural structures will select oxytocin, the bonding hormone, to soothe itself. But where there is an overload of stress coming from the mother and hence the absence of oxytocin’s emotional generator, its opposing hormone, cortisol, will come to play a pivotal role in the baby’s neural system. Then the baby will seek soothing not through the route of bond, touch, or holding, but by being overstimulated so that cortisol is elevated and he or she finds release through cortisol’s narcotising properties.

In a reprise of Simone de Beauvoir’s (1949) famous aphorism, “Women are made not born,” I want to say that bodies are made, not born. And I think we have no difficulty recognizing that to be so. If we think about it, it becomes obvious that the bodies we occupy are the embodiment of our parental bodies and our sibling bodies, their relation to our bodies, their wishes for our bodies, their projections onto our bodies, and our making what we can of their bodies in our body. It was the great distinction of psychoanalysis, and indeed an important part of Breuer and Freud’s (1893-1895) project, to try to understand this making of the body, the way the revered property, mind-that great quasidemocratic invention of the 19th century-could work to create physical problems that have no organic basis. Perplexing behaviors such as paralysis of the leg, or an imagined pregnancy with swelling (Anna O), or involuntarily speaking in a foreign tongue became the exquisitely bespoken symptoms for the conflicts, dilemmas, and distresses afflicting the soul, the psyche, but that could not, in bourgeois society, be uttered directly.

But, although our psychoanalytic forefathers were pioneers in exploring that psyche-soma membrane, psychoanalysis of late has had a lazy attitude toward the body, despite the presence in our consulting rooms of people in various degrees of discomfort with their bodies. Perhaps lazy is the wrong word. Perhaps I mean to say that we have become too facile, too quick to turn something articulated by our patients as a body-based difficulty into something other than how they perceive it or originally present it. We have come to see the body in many different ways. It is the elephant that never forgets what has happened to the person-the body as a place of remembered trauma. It is the body as a site of truth and the keeper of truth. It is the body as a garbage dump for all the emotional disquiets the mind cannot bear.

Rarely is it the body qua body, for the accounts of the body we hear, if we can hear them, can be so utterly disturbing and personally challenging that, in place of engagement, we find ourselves slipping into one or another mode of translation. It is not easy to sit with a patient who has sliced so deeply into her breast tissue that, at triage, she is leapfrogged over other patients with visible emergencies. It isn’t easy to sit with an “attractive” yet dysmorphic young girl of nine who cannot leave her bedroom to go to the living room, let alone attend school, unless she is covered in photographic-shoot quality makeup and has made sure that no unsightly hair emanates from her body. It isn’t easy to be with oneself when a male patient’s physical presence radiates a menacing charge evoking a claustrophobic fear in the countertransference.

Such states of being, which our patients and patients of our supervisees inhabit, are so challenging that we unwittingly turn away from the horror and distress they engender in us. We can find ourselves being ever so clever and making language about emotional pain. Our longing, my longing, is that my patient not suffer so, that my patient feel less impelled to physically attack inside or outside of himself or herself. I want something to quiet my own and my patient’s pain. But, if I am not careful, what has so moved me in the patient’s vernacular becomes displaced by words of mine, which make the body a symbolic referent rather than the site for the enunciation of extreme distress.

And yet, as long as we avoid the hatred, terror, and horror that patients locate in their bodies as being also about the body, we are unable to understand, address, or meet their distress or their longings at the appropriate level. seeing bodily symptoms and behaviors only metaphorically risks leaving them stranded with transliteration rather than a potential antidote. We fall into an epistemological trap in which we forget, or fail to consider, the ways in which, the body is a relational body, presents itself in our consulting room as responding to, in dialogue with and needing, our body (Orbach, 1995; Aron and Anderson, 1998). No less than our strictly psychological capacities-if I may separate them out for the moment-our bodies form part of the intersubjective relating in the room. Our body is part of the patient’s bodily experience, and our personal experience of our own body is affected by our sense of the patient’s body and what we pick up as his or her sense of our body.

Our body is not veiled and impenetrable, even if we sit at the side of or behind the patient. Our body, with its lumps, its bumps, its sighs, its smells, its sartorial endrapings, its stillness, its energy is visible, a physical transmitter and receiver of corporeality. Our patients register in less than 1/1200th of a second their responses to our body just as we register theirs (Dimberg, Thunberg, and Elmehed, 2000). Without conscious awareness we have sent out a visual acknowledgment of the impact of their corporeality on our own. We slow or quicken our pace, we open our body out or constrain it, we smile weakly, reluctantly, or enthusiastically, we create mood and physical ambience-all outside the realm of intentionality. And with our various physical registerings and gestures, we invite possibility, take on a range of transference-countertransference positions and entwinements that will provide part of the corporeal force field for our engagement.

Of course, this is an important aspect of how we are as speakers or seminar leaders. We present ourselves as embodied lecturers. When I am giving a talk, my body and the way I deliver what I have to say may resonate with my audience’s body collectively, or it may irritate individuals in the audience. In the presence of certain people, we may feel our bodies breathe more easily: when presenting ideas to those whose thoughts jibe with mine and whose writings of their clinical work and theoretical advances inspire me, my body is more open and receptive than it would be with an uncongenial, nonpsychoanalytic audience. It is perhaps too commonplace to say that, when one anticipates a hearing, a generosity, an engagement with the idea of the relational body, one’s own body expresses that mutuality and receptivity.

When I give a talk or presentation, I am eager to know what the audience looks and feels like. How the bodies of an as yet unseen audience, whose work I admire, will appear to me; how such bodies and voices delight and surprise my senses as I match up my idea of, for example, the relational psychoanalytic community through its writings, with my physical experience of the individuals that constitute it.

This is just a part of the collective intersubjective milieu that we do not consciously reflect on as we speak. One does not attune purposefully. But at work, in the consulting room, I scrutinize my countertransference and the corporeal intersubjectivity. I have concluded that we need to retheorize our work to take account of the body as body: to understand the body’s psychological development and the body’s subjectivity and intersubjectivity, to register the body countertransferences, and to see what is asked of our bodies in the consulting room by our patients. For our patients to have desiring bodies that are pleasurable and generative to them, they need to have bodies in the first place.

Burning Bodies

Colette was a capable, nimble, spiritually inclined 38-year-old mother of four. She grew up in India, the third daughter of a British colonial doctor and a French Egyptian mother. She was educated in British schools, at Cambridge, and then at Harvard and gave up a career as a philosophy teacher when she married her successful musician husband and started a family. Colette and her siblings had been intermittently bulimic since adolescence. Mother was particular about her food, but the family dining table in India was plentiful and enjoyable, resplendent with foods from Arabia, India, and France. Colette remembers the atmosphere and the food very fondly, particularly compared with the privations of the British boarding school. The maids entertained the children in the kitchen and delighted in giving them special treats.

Away from home and back at boarding school, Colette became bulimic after stuffing on white bread and jam, and, when she went to university, eating and vomiting began and became entrenched for the next 20 years. Daily encounters with her body’s insistent demand for food, and an equally persistent reflex to purge, were her most reliable and regular activities.

Colette had never felt quite right in her skin. These were the words she uttered as she explained her strict gym schedule or her dilemma on a family holiday when she would have to let go of her sarong and strip down to a swimsuit for the beach. By any kind of Western cultural standard, Colette was extremely good looking and stylish and appeared almost nonchalantly comfortable in her body in a way that might have one envying the French their style. Indeed, beside her, I felt dowdy and shabby. I would notice minor debris on my jacket, my hair would inevitably be having a bad day: it was as though I had forgotten how to dress. Charmed by her aesthetic and wistful of ever having such savoir faire, I would scan her for hints. It was an odd response. Just a session earlier I felt physically settled; a session later, too. Not that I would have minded having her subtly stitched jacket or her skirt with extra flair, but I had been free of body-focused desire or body distress, unencumbered by such wildcat body counter-transferences.

Colette had transferred, or I had picked up, it seemed, a considerable and uncomfortable lack of well-being in my body. It got so that, on realizing that it was her day to come, I would pay special attention to my clothes and shoes. I did not want to inflict on myself the internal buzzing of body disdain; I did not want to scrutinize myself as abject-it was too disconcerting. Other gorgeous women in my practice did not engender such feelings in me or send me, fretting, to my own wardrobe. Their physicality may have pleased me or awed me, but it was rare for me, in the consulting room, to feel I inhabited such a disagreeable, disgruntled body myself. I knew that what I was experiencing was likely to be some complex version of Colette’s own internal body representations, the object-relational aspects she had internalized from her mother, my longings for her to delight in her physicality, and my own complex history as a woman of this moment in history in which visual culture has cast our bodies as a site of hypercriticism.

What I felt myself to be observing was the operation of a false body: a body that had adapted, that had created itself in the absence of a relation to a potential or “true” body (Orbach, 1986), a body, to paraphrase Winnicott’s (1965) idea of the false self, whose existence was so fragile that it came alive only in response to the recovery from impingement. Winnicott suggested that the false self develops when the mother has been unable to respond to the infant’s gesture and instead seeks confirmation by way of the infant’s reception of her gesture. Then her own rather fragile sense of self and of her mothering capabilities is confirmed. While the mother feels reassured, the infant develops a “false” self that depends on adapting and shaping itself to what the mother or caregiver can receive.

Winnicott gives us a profoundly relational story as the building blocks for the defense structure. We see the layers of objectrelational internalization and protections that occur to keep a shaky foundation going. Colette’s story fit this picture. Her mother was a stylish woman, much concerned with her appearance in seemingly girlish ways. Today at 70, she still looks elegant and well groomed and plays tennis to keep her figure trim. When Colette talks about her, I see the transmission of one false body to another-a reverse Russian doll, the mother inside the daughter. Both women learned to look great, but certainly both felt very far from great or even content. As Colette told me and enacted for me in the consulting room, my body received and embodied the aspects of the body-to-body relational mismatching that had created such problems at a corporeal level for Colette.

My clinical quandary has been how to enable Colette to have a body. With many other patients who have experienced body distress, the therapy has gone through a process that, for the sake of brevity, I will summarize as follows. The therapeutic stance is one of accepting the hated body. I do not in any way deny the patient’s experience of her intense dislike of her body. To do so would be to demonstrate gross misunderstanding of a crucial aspect of the patient’s experience. Of course, there is also a part of the patient that may feel able to accept aspects of her body and find it pleasing from time to time and that an alternative sense of her body can be used to hold us together as we tolerate the very difficult feelings around hatred, unacceptability, abhorrence, and so on. But we cannot rely on that. The therapeutic task is not to be appalled and frightened by the hatred but to maintain a curiosity toward it: why, how, in what ways, always, forever?

This stance makes possible a joint exploration into the deconstruction of the monolith that is the hated body and an opening up of a dialogue through which we endeavor to understand how it has come to be experienced in that way. In the course of this examination, it is inevitable that we engage with where this sense came from and what is so adhesive about this idea. For many women such a discussion will involve deep anger at the damaged or hated body they have inherited, and they rail at the “mother object” or “father object” or those who first conveyed the sense of body hatred and invested that body with its dire sense of not being all right.

But as we know well, insight alone is an insufficient antidote. Understanding the origins of body hatred may, rather than releasing the person, demonstrate her unconscious allegiance to this idea and the fact that, if the patient could only get her body to be all right, she would be released from her pain. This turning back to oneself to continually fix the body is a physical version of a fearsome allegiance to an internalized bad object relation, and this can become very clear to patients. They begin to see their attempt to change, perfect, or improve their body as the attempt to woo the persons (and objects) who so wounded them. The therapeutic task, then, is to move toward the recognition of the sadness and grief that this is the body relation one lives inside of and that has been instigated by one’s objects and to be aware of one’s powerlessness to change what has existed and how it has come about.

The patient’s acceptance of this powerlessness paradoxically brings relief for grief and sadness about the shape of those body object-relational processes can now enter in. Recognizing what was and has precipitated down allows for something new to occur: a period of feeling lost and in mourning.

This process is something we are familiar with in the process of deconstructing defenses in general, and there is a very similar process when we engage with the difficult subjective feelings toward the body. Of course, this period of mourning can then produce feelings of being bodiless, as though one were living without a body that has any stability or recognizable dimensions. During such a period, the person may feel like a vessel with a surface and a large cavity. This can be a very difficult period in the therapy, particularly if the same feelings are simultaneously evoked in the countertransference so that there are, as it were, two bodiless people in the room.

In time, but not in any linear fashion, the therapeutic space fills with pain. As the patient lives through and digests that pain, she begins to experience something more than just being voided. She feels vulnerable and precarious in her body but can intermittently begin to experience that there is a body in the room that is available for use and engagement-the therapist’s body. By sharing the therapist’s body and internalizing the desire of the therapist for the patient to have a body, and through the therapist’s acceptance and offer of a body, the patient, in time, and slowly, begins to develop an internal body that is alive and of use to herself.

In this process, which I have telescoped and which never proceeds quite in the way I describe, attributes and ways of being from the adapted false or defended body are gradually (re)incorporated so that the new body is not alien but contains reconfigured aspects of the old body, which can now be generative, rather than responding, as Winnicott (1965) would say, to emergencies.

In this journey from dispossessing the hated body to accepting the experiential reality of body dysmorphia, to the gradual emergence of a previously undeveloped body, my body, or, rather, the co-created body that I inhabited in the consulting room, has been an important part of the means by which the emergent body of my patient has taken off. This phenomenon is parallel to the ways in which our clinical psyches operate as external and potentially available internalizing psyches during the deconstructive and reconstructive periods of analysis. I have written elsewhere of the astounding ingenuity of one particular patient, Herta, with a troubled body, who managed to create in me at a physical level many years back now, the sense that my body was so absolutely content that it was like a purring pussy cat (Orbach, 1995). With Herta, my purring body became the means by which she could relinquish her hated, diseased body. She had needed a body in the room that was wonderfully at peace and bountiful, and she had conjured up one for me to hold and inhabit since she was not able yet to do so for herself.

But with Colette no such access point was available. In true Rackerian (Racker, 1968) fashion, I had received the concordant physical correlate to Colette’s body. I felt shabby, unattractive, dowdy. I had a sense of how disagreeable it was to live in her body despite its lithely toned, pizazzily dressed appearance. I felt the longing to have as pleasing a body as I perceived hers to be from my now-physical stance, but I could not find the part of me that could exist as a neutral or positive body for the two of us while we entered the territory of deconstructing her body.

We worked directly on her body difficulty. Her spiritual practices led her to daily meditations. At the gym, she would practice taking off her clothes in front of the other gym members and then walking to the shower and going to the swimming pool with just the skimpiest of towels, which she let slip before the pool’s edge. She tried to let her husband’s pleasure with her permeate inside. But the embrace that I felt was requiredI don’t mean my physically holding her but my holding her body in mind, my sensual/psychic taking of her body into my body so that it could nestle in, be protected, and in time experience itself as precious and adored-could not happen because my body, now depleted of its usual capacities, felt so clipped, so useless, so incapable of offering anything of value.

After one session, I went to write my notes and experienced intense burning across my skin. I felt I was on fire. At the next session Colette recounted, for the first time, the story of a baby brother, younger than two years, who had fallen from a shelf above the stove onto the range and burned to death while in the care of his paternal grandparents and their servants in Egypt. Colette was not yet born. I was astounded and sorrowful. Colette had found a way to convey viscerally to me a bodily experience that had formed an aspect of her physical sense of self.

At a conscious level, Colette’s corporeal sense of her mother was of a beautiful woman who dressed magnificently. Colette would love to sit on her mother’s bed in India watching a servant arrange glamorous hairdos and pamper her while long white voile curtains billowed around the room. Mother would spray a little perfume on Colette and throw a scarf around the child’s shoulders to imply that this glamour would one day be hers. This time with her mother was a great source of pleasure to Colette, but it belied an overlay of another body sense, the burning body, which I conjectured also emanated from her mother and which I had picked up in my body countertransference. This burning sensation seemed to me to encode a sense of grief, horror, agony, shame, fear, and hesitation that may have lain inside her mother’s body and that her mother brought to her physical mothering of Colette. I imagined that I had experienced Colette’s burning as Colette had experienced her mother experiencing her child burning and her own shame and agony burning

Colette did not talk about being touched much as a child by Mother, although she was hugged a great deal by the maids and was a very tactile mother herself. Colette and her siblings all had eating problems and pretty unhappy sexuality issues. The body-to-body relationship that they had internalized was a body I suspected was full of shame, lamentation, anguish, fear, and hesitation, which, I surmised from my body countertransference, was unacknowledged and thus precipitated into an inert body terror that was not amenable to dispersement; it could only be passed on.

Of course I could not know, but by using the words anguish, shame, lament, hesitant, and fearful to talk about the mother’s subjectivity and the physical ambience of Colette’s childhood, I was able to yank myself away from the contaminating aspects of the self-hating body countertransference I had taken on. I found myself with a body that was more receptive; filled now not with contentment in any sense but, in place of the dismal and second-class body I felt in so many of Colette’s sessions, my body was now reequilibrated with the far more manageable feelings of desolation, bleakness, and sorrow.

Working through these emotional cadences in my body and finding words to speak of bodies that were desolate, bleak, and sorrowful, we began to break up the viscera of Colette’s monolithically false body and to enliven it, albeit with painful affective states of sorrow and sadness. In the sequence, which, of course, was not a sequence but a jumble of back-and-forth engagements, Colette began to mourn the body she never had: the “free” body of childhood, the expectant body of adolescence, the delighted body of young adulthood. Encountering these imagined missing bodies was itself particularly poignant, enunciating as it did loss, longing, and dismay. Now she wanted what she called her body and not her mother’s.

As she articulated this wish, I began to feel less of a frump. My body was no longer primarily the abject (maternal?) body. It could be my contemporary body, feeling with, empathie to, her contemporary body. Her comments on my footwear-my little yellow shoes or pink kitten heels-became the means by which I knew she was finding my body of some value. She was not walled off from it; and I, richer now with my version of how I understood her pain, had a body too. It did not feel as though she were appreciating just its surface. It felt as though she were absorbing a body that was there for itself and for her. My longing for Colette to have a vivified body and her ability now to feel great distress rather than be marooned in hate had allowed her body to be on the move.

Where previous therapies had, if not jollied her along, tried to tell her that she had transferred her self-hatred to the body and then left her stranded with this immovable hated body, she had, through the body countertransference, found a compelling way for me to focus on her body as a significant experience on its own terms and not ignore or translate the discomfort with which we were both living. We began to understand her bulimic behaviors as not simply a management of difficult feelings but more as a way of swaddling a body that had no emotional myelin. The 20+ years of stuffing and vomiting, the frequent trips to the gym, were not only to quiet this body but also to try to find a body: to make it real, to create and survive the emergencies and thus reassure herself of her physical existence.

The Search for a Body

Body difficulties whether expressed as eating problems or through painful body practices, are ubiquitous in our consulting rooms (Bloom et al., 1994). Everywhere in the culture we see evidence of the search for a body. Bodies in our time have become sites of display and volatility, but so unstably that performance and enactment become desperate and often compulsive attempts at recognition. Are those middle-school children on the school bus who are giving and receiving blow jobs at age 11 expressing sexual curiosity? Perhaps. Are those teenagers who are hooking up or making friendships with benefits just loving their sexuality? Perhaps. Are those body builders simply going for strength and endurance? Perhaps. Are the teenage cutters who make ready with the knives in countless girls’ schools across the United Kingdom creating a branding for themselves? Perhaps. Are the cyberidentities in which body is an interchangeable but essential category just fun? I wonder. Are the multiple bodies of those of our patients who inhabit different self-states or who are diagnosed with dissociative identity disorder expressing bodies of choice? For sure, no. Is the person who needs a leg removed because, despite its being a phantom and no longer existing, it feels in the way? Is the person who craves plastic surgery, even the face of a celebrity, vain? I think not. I think we can understand these yearnings, rather, as cris de corps manques: as evidence of the desire and longing for a body, a body that feels, is touched, and can be touched; a body that is affectively organized, rather than disorganized, sensations craving management.

It has become a feature of postmodernism to celebrate multiplicity, to valorize fluidity over knowing and complexity over simplicity, and to see embodiment, like femininity and masculinity, as performative flexibilities (Butler, 1990). A kind of antihierarchy of provisionality has been a mode of interpretative discourse, a sophisticated version of equivocation in which an idea contradicts itself in the second clause of the sentence by dazzling arrangements of words in which we find and lose ourselves in the same moment. With psychoanalysis as poetry, corporeality is a synthetic, symbolic construct and not in any sense a place or displaced site of existence.

Playful and engaging as such ideas can be within literary theory where they are most pronounced, they are not playful or engaging for our patients whose corporeal rudderlessness propels them to seek extreme solutions to their physical incongruities. Postmodern theory is too thin, too insufficient to cope with the demands of the postindustrial body. It celebrates the fragmentation that requires, by contrast, understanding, deconstructing, nourishing, and then knitting together. People do not live easily in the disorganized and disorganizing bodies they speak of or show up in-I am thinking now of patients whose wardrobes are so various and jangled as to engender in the observer a sense of not knowing from session to session whom one is encountering.

The labile bodies we encounter in the consulting room are on a search for anchoring. Once secured, perhaps playfulness and masquerade can follow. But there needs to be a body there for the person in the first instance. The celebrating of numerous self/body states that is found in the postmodernist approach can play into and almost applauds the distress of the preintegrated bodies. By elevating multiplicity as a form of relief to our patients we may unwittingly dismiss the ways in which each person seeks corporeal coherence. For my patients, and many of those of my supervisees, the joy, or even the more florid claim of performativity, is a nonstarter. The raw material of the body is saturated with the damaged bodies of their internal body relationships. They need us to be able to sit with the horror that pervades their corporeality/ies, not interpret it. Of course, the multiple body states are not to be dismissed. We welcome them as we welcome the oft-expressed “bodylessness.” There is much to learn from engaging with the many physical corporealities that take up residence in a patient. Clinicians, I believe, know this. And some of my critique of Butler’s (1990) position comes from our different relation to bodies as objects of study. For us psychoanalysts, our affect-laden relation to our various body states and those of our patients is palpable and leads us to different conclusions about what labile body counter-transferences tell us about the stability or instability of the patient’s (and our own) body.

Many patients present with body unhappiness. We almost take it for granted and can miss the severity of their dis-ease. The cultural imperatives to be fit and youthful infect us, too, and we can understand our patients’ desire and their shame, and the ways in which in everyday social intercourse and conversing, the strivings for our bodies, take on the weight of moral categories. Looking at them, as I looked at Colette, we might think there is little wrong with their bodies. We might even applaud their attempts at health and self-regulation, perhaps even wish for a dose of that very compulsivity ourselves. We might be concerned only when they want to do something that is at the extreme of the cultural practices on offer. In the United States, Argentina, and Brazil, plastic surgery would not cause alarm. Certainly at an IPA conference held in Sao Paolo four years ago, I was to discover how dated and what an oddball I appeared for not being lifted from head to tush. When a patient wants an operation on the labia or wants to have a perfectly healthy limb removed-not a phantom limb, but an existing body part that is perceived to be an absolute impediment, our squeamishness may alert us to dysmorphia considerably beyond the norm.

For the most part, though, we understand and empathize with their wish for a tummy tuck or unpuckered skin, or the desire for the posture, gait, and health of a younger person. How could it be otherwise in a postindustrial Westernized world in which the body has become a series of visual images and a labor process itself? And yet how could this not also be mad? The quotidian commentary on our body and its discontents expresses a culture that is bodily disenfranchised and has been since industrialization (Orbach, 2004). Our tragedy is that this gross social pathology is ours to experience individually and privately. We cannot give our patients the opportunity to find bodies for themselves because our anxieties about our own bodies can be so severe that sitting with two anxious or self-hating or bodyless bodies is too difficult.

People come to us when their defense structures are broken and no longer working. At least in the United Kingdom they do. They do not come simply for pedagogical or intellectual interest (despite there being a remnant of this kind of rhetoric in British psychoanalysis, as in the oft-stated, you are not there to help your patient). So, when it comes to confronting body difficulties, there can be hesitation, ignorance, or insufficient skill on the part of the analyst, which hinders work with a patient who suffers severe body hatred. It is, as we all know, easy enough to temporarily patch up someone with a body difficulty. We know how to do that, how to strengthen the existing defense structures so that they can keep on going through to the next crisis. It is particularly easy to agree to a makeshift repair plan-a new exercise regimen, a new diet, a weight-lifting program, a nutritional structure, a clothing revamp, and to see the plan as empowering and strengthening. We feel relieved; the patient feels relieved. But that’s the soft option and it is only a patch, a fudge.

Psychoanalysis’ aims are more ambitious than that. If we are interested in making it possible for others to be in their lives and to feel them as generative and animated, then a far more demanding engagement is required of us in relation to our own bodies and personal proclivities, discontents, and longings. This injunction is double edged and in the interests of both us and our patients. Our patients’ dilemmas and conflicts give us the opportunity and the impetus to look at the ways we, too, patch and fudge the troubling issues that may construct a less than satisfactory relation to our own bodies. It is one of those hidden pluses of the job that we have endless opportunities to confront our personal difficulties, and we have a much better chance of enabling our patients longings if we understand the instability we might experience in our own bodies.

A revitalized modernism that takes into its project the postmodern critique is surely what we require at the level of the theory to address the instability we observe and hear about in our patients’ bodies. Muriel Dimen (personal communication, 2005) has argued that psychoanalysis is a protopostmodern theory. She may well be right. And I may be saying the same thing. But my sensibilities incline me to express this as a need to create and revitalize modernism, a modernism that is both developmental and cultural-a modernism that may enable our patients and us to have bodies in which multiplicity and provisionality are pluralisms stemming from a flexible, dynamic, core corporeality that can be expansive, can age, and can be genuinely playful.

Perhaps we might avoid what Stan Cohen (2001), the leading expert on torture, has said about the Big Brother reality TV aspect of the Abu Graib perpetrators documenting and filming their own excursions into body cruelty. Although documentation is part of the history of torture, the filming of the sadistic endeavors as a pastime should give us pause. We have entered a new territory which reveals the abject nature of our current corporeality.

Jean Paul Sartre was sent as a baby to a wet nurse where he reports that he did his “best to die” (Sartre, 1964). Sharing a room with his mother, who he thought was his sister, he was largely unseen and unlooked after by his family until, with consternation, his grandfather pronounced his feminine curls an affront and that they must go lest Jean Paul become a milksop. Sartre’s physicality unembraced, he forsook, as far as he could, the materiality of his existence and made himself, through words, “indispensable to the universe.” In his autobiographical account, Sartre, standing at the end of modernism, prefigures an experience of the Western body that was to become ubiquitous through the later decades of the last century.

My patients are still fighting to be embodied. Unless we address the absent, hated, hurting body, we will prevent our patients from having bodies that are enlivening and creative. Whether it is Colette’s bulimia, weight training, cutting, or ritualistic physical practices, they have not given up. Their actions can be understood as attempts to get a body for themselves.